Determines if pre-certification or prior authorization is needed on any scheduled test or procedure by contacting patient’s carrier for information. Obtains information needed to obtain pre-certification from proper source for payor. Ensures that communication to / from ordering physician’s office is professional and efficient to retrieve all necessary information to obtain pre-cert or prior authorization for that office. Notifies ordering physician’s office if additional information is needed. Documents pre-certification number in appropriate area of patient’s record. Documents, in notes, all communication including, but not limited to, reference #s, people spoken with, etc. Notifies office if pre-certification cannot be obtained, provides additional information needed for authorization and notifies patient if procedure needs to be rescheduled until a date once authorization is obtained. Ensures the effective management of all Scheduling, Authorizations and Pre-Registration and the transition of the inquiries to the appropriate service lines. Communicates with scheduling so that test can be removed from the schedule or changed. Completes/distributes paperwork, entering pertinent patient information into Hospital Information System, verifying insurance benefits and eligibility, identifying out of pocket cost, and communicating with staff and patients on point of cash requirements on/before service date. Performs job duties in accordance with the policies and mission of Russell Medical Center. Performs multiple tasks simultaneously keeping information organized for processing. Depending on the needs of the organization and the department, becomes cross-trained to fulfill other roles when asked. Follows all departmental and hospital polices. Ensures customer service policies and guidelines are followed.
• Education: Minimum of high school diploma, some college preferred.
• Experience: Minimum of 2 years clinical experience preferred, knowledge of pre-certification procedures preferred, excellent customer service skills, computer background, knowledge of keyboard, and typing (minimum of 40 wpm). Medical terminology preferred.
• Licenses, Certifications and/or Registrations: None
• Equipment, tools, work aids: Copy Machine, calculator, fax machine, Meditech, Windows, credit/debit card machine, printer as well as compliance checker.
• Specialized Knowledge and Skills: Pre-certification and Prior Authorization Process, Problem Solving, Multi-tasking and Organizational skills.
Full Time with benefits
Hours: Monday-Friday 8am-5pm